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Ethics II > PAS > Flashcards

PAS Flashcards

1
Q

What is the science view of death? Psychological? Law/regulation?

A

Science = Make death a medical problem by controlling its causes

Psych = Put death out of sight

Law/regulation = Let people control how they want

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2
Q

What were the assumptions that were wrong with the SUPPORT study?

A
  • Pt can articulate preference
  • Preferences are stable
  • Parties will make decisions at critical junctions
  • Pts and surrogates will step forward and take responsibility for decisions
  • Decision-makers incorporate information rationally
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3
Q

What are the three characteristics of clinical decision making at the end of life?

A
  • Medically complex
  • Personally demanding
  • Evolve over time
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4
Q

True or false: the SUPPORT study concluded that an autonomy based framework is the best means of making decisions at the end of life?

A

False–fell short of expectations

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5
Q

What is the pattern of function/time for patients with organ failure?

A

“sawtooth pattern”–intermittent bouts of decreased function, but a general downward trend

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6
Q

What are the beneficence/ nonmaleficence aspects of palliative care?

A
  • Optimize QOL
  • Cover the continuum of illness
  • Aggressive symptom management
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7
Q

What are the autonomy aspects of palliative care?

A

Patient and family centered decision making that is supportive

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8
Q

What is the scope of palliative care? (5)

A
  • Physical
  • Intellectual
  • Emotional
  • Social
  • Spiritual
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9
Q

What are the 7 goals of care?

A
  1. Be cured
  2. Live longer
  3. Improve or maintain function / QOL
  4. Be comfortable
  5. Achieve life goals
  6. Family support
  7. Clarify diagnoses / prognoses

FLACCID

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10
Q

What is the major difference between the paternalistic model, shared decision making model, and the informed model of medical care?

A

Both the information exchange, deliberation, and ultimate decision are based on patient and doctor decision making, instead of one or ther other

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11
Q

What is the best question to ask regarding end of life care?

A

“what are your goals of care”? (which of the 7)

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12
Q

What is the best way to ask questions when first meeting patients, or beginning a conversation of end of life care (generally)?

A

Open-ended ones

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13
Q

When should a discussion about goals be done, relative to treatment?

A

Before treatment / intervention

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14
Q

Where should cost factor into the decision about treatment?

A

Not at the bedside–“Hidden in the shadows”

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15
Q

What is the MOA of venlafaxine?

A

SNRI (Effexor)

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16
Q

What is the use and MOA of rifaximin?

A

Non-absorbable abx used in the treatment of bowel infections.

interferes with transcription by binding to the β-subunit of bacterial RNA polymerase

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17
Q

What are the factors that should be considered with any treatment decision? (4)

A
  • Goals
  • costs
  • Treatment burden
  • Probability of outcome
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18
Q

What are the 5 steps of the spectrum toward end of life?

A
  • Withhold
  • Withdraw
  • Intensive palliation
  • Palliative sedation
  • PAS
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19
Q

What is the opinion of the AAHPM on the moral and legal views of withholding / withdrawing and PAS

A
  • Morally the same and appropriate

- Legally distinct from PAS

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20
Q

What is the difference between DNRs and advanced directives?

A
  • Advance directives are directions for future care

- DNR are orders for now

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21
Q

What is the purpose of advanced directives?

A

To increase the likelihood that patients’ treatment preferences will be honored when the can no longer speak for themselves

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22
Q

What are the two types of advance directives?

A

Living will

Durable power of attorney

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23
Q

What is a living will?

A

Spelled out decisions of one’s own medical preferences

24
Q

What is durable power of attorney?

A

Names someone else to make medical choices on behalf of the patient

25
Q

What are the conditions in which a living will becomes applicable?

A

Patient is incapacitated and:
-Patient’s condition is terminal
OR
-Permanently unconscious

26
Q

What is the order of authority of medical decision makers if a pt is incapacitated w/o a living will or DPOA?

A
  1. Guardian
  2. Spouse
  3. Adult children
  4. Parents
  5. Adult sibling
27
Q

What are the two legal standards that people with the durable power of attorney must abide by?

A
  • In accordance with the desires of the patient

- Is in the best interest of the patient

28
Q

If a patient’s desires are completely unknown, what guides your decision making?

A

Act in the best interest of the patient

29
Q

What is the physician’s conscious clause?

A

A health care provider is not subject to criminal prosecution, etc for failing to withhold or withdraw health care necessary to keep the patient alive

30
Q

What is the IPOST?

A

Order form that is active as soon as it’s signed–specifies the type of care wanted, who makes decisions, and rationale for care.

31
Q

What are the two signatures that are needed on an IPOST?

A

Healthcare provider + patient or appointed guardian

32
Q

True or false: by law, you have to follow IPOST all the time

A

False

33
Q

What are the two forms of advanced directives where power may be exercised without the patient being terminally ill or permanently unconscious?

A

Durable POA

IPOST

34
Q

What is the intention of the DNR?

A

Preserve comfort, not to cause or hasten death

35
Q

What is the difference between palliative and terminal sedation?

A

Palliative sedation = treating with sedation to control pain, with possibility of death as outcome

Terminal sedation = sedate to kill

36
Q

What are the two questions that should be asked when withholding/withdrawing?

A

What is intended?

What causes death

37
Q

What is the principle of double effect?

A

To justify foreseen but unintended negative consequences of a good intervention

Fits that paradigm of a side effect

38
Q

What are the 4 qualifications of the principle of double effect?

A

The action:

  1. Is not itself unethical
  2. Only intends the good effect
  3. Does not achieve the good effect by means of the bad
  4. Do for a proportionately serious reasons
39
Q

What is the definition of PAS?

A

Medical help is provided to enable a patient to perform an act the is specifically intended to take his or her own lift

40
Q

What is the the difference between euthanasia and PAS?

A

Euthanasia is when the physician performs the act that is intended to take the lift of a patient.

41
Q

True or false: semantics are heavily debated with PAS

A

True

42
Q

What is the oath that goes against PAS?

A

Hippocratic oath

43
Q

What happen to the disagreement with PAS in drs who have higher numbers of terminally ill patients?

A

More disagreement with taking care of more terminally ill patients

44
Q

What was the outcome of the supreme court ruling in 1997 in terms of PAS?

A

There is no constitutional right to PAS

45
Q

True or false: nearly all patients who receive medications to commit suicide use them

A

False–most do not use them

46
Q

What percent of patient wish for PAS d/t insufferable pain?

A

25%

47
Q

Generally, is the power of the Durable POA restricted or unrestricted by clinical situations?

A

Unrestricted

48
Q

True or false: IPOSTs can be used for both children and adults

A

True

49
Q

True or false: IPOSTS are restricted to those people with terminal illness or permanent unconsciousness

A

False–not restricted

50
Q

Which takes precedence in case of conflict: an IPOST, vs a DPOA, living will etc

A

DPOA or living will will each take precedence over an IPOST

51
Q

What is the major issue of the principle of double effect in terms of treating pain with morphine?

A

May prolong the death of patients

52
Q

What is the motivation for palliative care vs PAS?

A
  • Respect persons with palliative care

- Respect choice with PAS

53
Q

What is the intention with Palliative care vs PAS?

A

Palliative care = comfort

PAS = death

54
Q

What is the outcome of Palliative care vs PAS?

A

Palliative care = life of death

PAS = death

55
Q

What is the cause of death with Palliative care vs PAS?

A

Palliative care = disease

PAS = medication

56
Q

Should autonomy be the foundation for human dignity?

A

No (human value should not be equated with the ability to make choices)

Ethics II (16 decks)

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